title: Relapses in recurrent depression 1 year after maintenance cognitive-behavioral therapy: the role of therapist adherence, competence, and the therapeutic alliance.
abstract: The prevention of relapse in recurrent depression is considered a central aim in cognitive-behavioral therapy, given the high risk of relapse. In this study, patients with recurrent major depressive disorder (currently remitted) received 16 sessions of Maintenance Cognitive-Behavioral Therapy (M-CBT) over a period of 8 months, in order to prevent relapse. Therapist adherence and competence, as well as the therapeutic alliance, were investigated as predictors for reducing the risk of recurrence in depression. Videotapes of 80 participants were analyzed in order to evaluate therapist adherence and competence. Additionally, the therapeutic alliance was assessed by questionnaire. No associations were found between therapist adherence or competence, and the risk of relapse 1 year after treatment. By contrast, the therapeutic alliance was a significant predictor of the time to relapse. Moreover, we found that the number of previous depressive episodes (≥ 5 vs. ≤ 4) was a significant moderator variable. This indicates that the alliance-outcome relationship was particularly important when patients with five or more previous depressive episodes were taken into account, in comparison to patients with four or fewer episodes. For the psychotherapeutic treatment of recurrent depression and the prevention of relapse, sufficient attention should be paid to the therapeutic alliance.
authors.affiliation: Department of Clinical Psychology and Psychotherapy, University of Frankfurt, Frankfurt, Germany. Electronic address: weck@psych.uni-frankfurt.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Weck
authors.forename: Visar
authors.initials: V
authors.lastname: Rudari
authors.forename: Christine
authors.initials: C
authors.lastname: Hilling
authors.forename: Martin
authors.initials: M
authors.lastname: Hautzinger
authors.forename: Thomas
authors.initials: T
authors.lastname: Heidenreich
authors.forename: Karin
authors.initials: K
authors.lastname: Schermelleh-Engel
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stangier
mesh_terms: D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000517:prevention & control / Q000523:psychology* / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011361:Professional Competence; D012044:Regression Analysis; D055502:Secondary Prevention; D011795:Surveys and Questionnaires; D014741:Video Recording; D055815:Young Adult
keywords: Adherence; Alliance; Competence; Maintenance cognitive therapy; Outcome; Recurrent depression